Psychologically disturbed about his
disease condition- anticipating it as a life threatening condition.
Patient is in depressive mood and does not interacting.

Patient is disturbed by the thoughts
that he became a burden to his children with so many serious illnesses
which made them to stay with him at hospital.

Patient has pitting type of edema
over the ankle region, and it is more during the evening and will not
be relieved by elevation of the affected extremities.

He had developed BPH few months back
(2008 January) and underwent surgery TURP on January 17. Still he has
mild difficulty in initiating the stream of urine.

Patient is a known case of Diabetes
since last 28 years and for the last 4 years he is on Inj. H.Insulin
(4U-0-0). It is adding up his distress regarding his health.

Life style patterns

patient is a retired school teacher

cares for wife and other family members

living with his son and his family

active in church

participates in community group meeting i.e. local politics

has a supportive spouse and family

taking mixed diet

no habits of smoking or drinking

spends leisure time by reading news paper, watching TV, spending time with family members and relatives

Have you experienced a similar problem?

The fatigue is similar to that of previous hospitalization (after the surgery of the BPH)

Severity of pain was some what similar in the previous time of surgery i.e. TURP.

Was psychologically disturbed during the previous surgery i.e. TURP.

What helped then- family members psychological support helped him to over come the crisis situation

Anticipation of the future

Concerns about the healthy and speedy recovery.

Anticipation of changes in the lifestyle and food habits

Anticipating about the demands of modified life style

Anticipating the needs of future follow up

What doing to help himself?

Talking to his friends and relatives

Reading the religious materials i.e. reading the Bible

Instillation of positive thoughts
i.e. planning about the activities to be resume after discharge,
spending time with grand children, going to the church, return back to
the social interactions etc

Avoiding the negative thoughts
i.e. diverts the attentions from the pain or difficulties, try to
eliminate the disturbing thoughts about the disease and surgery etc

Trying to accept the reality etc..

What is expected of others?

Family members visiting the patient and spending some time with him will help to a great extent to relieve his tension.

Convey a warm and accepting behaviour towards him.

Family members will help him to meet his own personal needs as much as possible.

Involve the patient also in taking decisions about his own care, treatment, follow up etc

STRESSORS AS PERCEIVED BY THE CARE GIVER.

Major stress areas

Persistent fatigue

Massive weight loss i.e.( 8 kg of body weight with in 4 months)

History of BPH and its surgery

Persistence of urinary symptoms (difficulty in initiating the stream of urine) and edema of the lower extremities

Persistent disease- chronic hypertensive since last 28 years

Depressive ideations and negative thoughts

Present circumstances differing from the usual pattern of living

Hospitalization

acute pain ( before the surgery
patient had pain because of the underlying pathology and after the
surgery pain is present at the surgical site)

nausea and vomiting which was present before the surgery and is still persisting after the surgery also

anticipatory anxiety concerns the recovery and prognosis of the disease

negative thoughts that he has become a burden to his children

Anticipatory anxiety concerning the restrictions after the surgery and the life style modifications which are to be followed.

Clients past experience with the similar situations

Patient verbalized that the
severity of pain, nausea, fatigue etc was similar to that of patient’s
previous surgery. Counter checked with the family members that what
they observed.

Psychologically disturbed previously
also before the surgery. (collected from the patient and counter
checked with the relatives)

Client perceived that the present
disease condition is much more severe than the previous condition. He
thinks it is a serious form of cancer and the recovery is very poor. So
patient is psychologically depressed.

Future anticipations

Client is capable of handling the situation- will need support and encouragement to do so.

He has the plans to go back home and to resume the activities which he was doing prior to the hospitalization.

He also planned in his mind about the future follow up ie continuation of chemotherapy

What client can do to help himself?

Patient is using his own coping strategies to adjust to the situations.

He is spending time to read religious books and also spends time in talking with others

He is trying to clarify his own doubts in an attempt to eliminate doubts and to instill hope.

He sets his major goal i.e. a healthy and speedy recovery.

Client's expectations of family, friends and caregivers

he sees the health care providers as a source pf information.

He tries to consider them as a significant members who can help to over come the stress

He seeks both psychological and physical support from the care givers, friends and family members

He sees the family members as helping hands and feels relaxed when they are with him.

Evaluation/ summary of impressions-

There is no apparent discrepancies identified between patients perception and the care givers perceptions.

INTRAPERSONAL FACTORS

1. Physical examination and investigations

Height- 162 cm

Weight – 42 kg

TPR- 37o C, 74 b/m, 14 breaths per min

BP- 130/78 mm of Hg

Eye- vision is normal, on examination
the appearance of eye is normal. Conjunctiva is pale in appearance.
Pupils reacting to the light.

Ear- appearance of ears normal. No wax deposition. Pinna is normal in appearance and hearing ability is also normal.

Cardiovascular system- heart rate is
76 per min. on auscultation no abnormalities detected. Edema is present
over the left ankle which is non pitting in nature.

GIT- patient has the complaints of
reduced appetite, nausea; vomiting etc. food intake is very less.
Mouth- on examination is normal. Bowel sounds are reduced. Abdomen
could not be palpated because of the presence of the surgical incision.
Bowel habits are not regular after the hospitalization

Extremities- range of motion of the
extremities are normal. Edema is present over the left ankle which is
non pitting in nature. Because of weakness and fatigue he is not able
to walk with out support

Genitor urinary system- patient has
difficulty in initiating the urine stream. No complaints of painful
micturation or difficulty in passing urine.

Self acre activities- perform some of
his activities, for getting up from the bed he needs some other
person’s support. To walk also he needs a support. He do his personal
care activities with the support from the others

Immunizations- it is been told that
he has taken the immunizations at the specific periods itself and he
also had taken hepatitis immunization around 8 years back

Sleep –. He told that sleep is
reduced because of the pain and other difficulties. Sleep is reduced
after the hospitalization because of the noisy environment.

Diet and nutrition- patient is taking
mixed diet, but the food intake is less when compared to previous food
intake because of the nausea and vomiting. Usually he takes food three
times a day.

Habits- patient does not have the habit of drinking or smoking.

Other complaints- patient has the complaints of pain fatigue, loss of appetite, dizziness, difficulty in urination, etc...

2. Psycho- socio cultural

Anxious about his condition

Depressive mood

Patient is a retired teacher and he is Christian by religion.

Studied up to BA

Married and has 4 children(2sons and 2 daughters)

Congenial home environment and good relationship with wife and children

Is active in the social activities at his native place and also actively involves in the religious activities too.

Good and congenial relationship with the neighbors

Has some good and close friend at his place and he actively interact with them. They also very supportive to him

Good social support system is present from the family as well as from the neighborhood

3. Developmental factors

Patient confidently says that he
had been worked for 32 years as a teacher and he was a very good
teacher for students and was a good coworker for the friends.

He told that he could manage the official and house hold activities very well

He was very active after the retirement and once he go back also he will resume the activities

4. Spiritual belief system

Patient is Christian by religion

He believes in got and used to go to church and also an active member in the religious activities.

He has a personal Bible and he used
to read it min of 2 times a day and also whenever he is worried or
tensed he used to pray or read Bible.

He has a good social support system present which helps him to keep his mind active.

INTERPERSONAL FACTORS

has supportive family and friends

good social interaction with others

good social support system is present

active in the agricultural works at home after the retirement

active in the religious activities.

Good interpersonal relationship with wife and the children

Good social adjustment present

EXTRAPERSONAL FACTORS

All the health care facilities are present at his place

All communication facilities, travel and transport facilities etc are present at his own place.

His house at a village which is not much far from the city and the facilities are available at the place.

Financially they are stable and are able to meet the treatment expenses.

Summary

Physiological- thin body built
pallor of extremities, yellowish discoloration of the mucus membrane
and sclera of eye. Nausea, vomiting, reduced appetite, reduced urinary
out put. Diagnosed to have periampullary carcinoma.

Psycho socio cultural factors-
patient is anxious abut his condition. Depressive mood. Not interacting
much with others. Good support system is present.

Instruct the
client to avoid the activities which causes
extreme fatigue

Provide the
necessary articles near the patients bed
side.

Assist the
patient in early ambulation

Monitor
client’s response to the activities in order
to reduce discomforts.

Provide
nutritious diet to the client.

Avoid
psychological distress to the client. Tell
the family members to be with him.

Schedule rest
periods because it helps to alleviate
fatigue

Instruct the
client to avoid the activities which causes
extreme fatigue.

Advice the
client to perform exercises to strengthen
the extremities& promote activities

Tell the
client to avoid the activities such as
straining at stool etc

Teach the
client about the importance of early
ambulation and assist the patient in early
ambulation

Teach the
mobility exercises appropriate for the
patient to improve the circulation

Encourage the
client to do the mobility exercises

Tell the
family members to provide nutritious diet in
a frequent intervals

Teach the
patient and the family about the
importance of psychological well being in
recovery.

Provide the
primary and secondary level care if
necessary.

Evaluation – patient verbalized that his activity level
improved. He is able to do some of his
activities with assistance. Fatigue relieved and
patient looks much more active and interactive.

NURSING DIAGNOSIS-III

Impaired physical mobility related to presence
of dressing, pain at the site of surgical
incision

Outcomes/goals: Patient will have improved physical mobility as
evidenced by walking with minimum support and
doing the activities in limit.

Nursing actions

Primary prevention

Secondary prevention

Tertiary prevention

Provide active and passive exercises to all the
extremities to improve the muscle tone and
strength.

Make the patient to perform the breathing exercises
which will strengthen the respiratory
muscle.

Massage the
upper and lower extremities which help to
improve the circulation.

Provide
articles near to the patient and encourage
doing activities within limits which
promote a feeling of well being.

Provide positive
reinforcement for even a small improvement to
increase the frequency of the desired activity.

Teach the mobility exercises appropriate for
the patient to improve the circulation and
to prevent contractures

Mobilize the patient and encourage him to do
so whenever possible

Motivate the client to involve in his own
care activities

Provide primary preventive measures whenever
necessary

Educate and reeducate the
client and family about the patients care
and recovery

Support the
patient, and family towards the attainment
of the goals

Coordinate the
care activities with the family members and
other disciplines like physiotherapy.

Teach the
importance of psychological well being which
influence indirectly the physical recovery

Provide primary
preventive measures whenever necessary

CONCLUSION

The Neuman’s
system model when applied in nursing practice
helped in identifying the interpersonal,
intrapersonal and extra personal stressors of
Mr. AM from various aspects. This was helpful to
provide care in a comprehensive manner. The
application of this theory revealed how well the
primary, secondary and tertiary prevention
interventions could be used for solving the
problems in the client.